Sex and diabetes

Diabetes and sexual dysfunction

Sex is an important part of relationships for adults of all ages. An unfulfilling sex life can lead to feelings of guilt and rejection, causing problems within a relationship. Levels of sexual desire vary widely between different people, and can change over time.

In this section ‘sexual dysfunction’ refers to having problems with vaginal lubrication and sensation in women, and the inability to produce and/or maintain an erection or having problems with sensation in men.

These sexual problems can be very difficult to discuss, particularly if the cause has not been identified. Therefore it’s important to know how to recognise the causes and symptoms of sexual dysfunction, so that it can be identified, discussed and treated or managed.

Sexual dysfunction is more common in people with diabetes because poorly controlled diabetes can damage the blood vessels and nervous system. In women, this can restrict blood flow to the vagina, causing dryness and interfering with arousal, and in men can restrict blood flow to the penis, causing erection problems.

In men and women, nerve damage can result in loss of sensation. Other problems associated with diabetes such as heart disease and depression can increase the chances of sexual dysfunction in people with diabetes. Medication taken for these or other conditions can also contribute.

Problems around sexual dysfunction are often complex, and can be connected to emotional factors such as relationship difficulties, poor self-image, embarassment and guilt. Tiredness, stress, alcohol, cigarettes and some recreational drugs also play their part.

Women and sexual dysfunction

Having diabetes doesn’t mean you will automatically develop female sexual dysfunction (FSD).

However, according to research, women with diabetes are twice as likely to experience problems as those without.

Although not as well researched as male sexual dysfunction, there is growing recognition that female sexual dysfunction is widely experienced.

So if you experience problems, you are not alone and more help is now available than in the past.

You may experience sexual dysfunction that is caused by physical factors or the medication you are taking, or a combination of both. As well as diabetes and related complications, emotional and lifestyle factors can also contribute to sexual dysfunction.

It is generally recognised that the four main areas of sexuality that women experiencing FSD find difficulty with are: desire, arousal, dyspareunia (pain with intercourse) and orgasm.
 
Experiencing a sexual problem can be hard to accept and come to terms with. As a result many couples shy away from talking about the problem due to embarrassment, frustration or feelings of guilt, especially if the cause is not understood. These emotions are normal responses, but may make the problem worse.  

It is important to be aware of some of the links between causes and symptoms so that you can seek the most effective help and support.

At present there is no medication available specifically for the treatment of FSD, but research is ongoing. However, treatments for women are currently available in the form of therapy and aids for lubrication and clitoral stimulation.

Men and sexual dysfunction

Having diabetes doesn’t mean you will automatically develop sexual dysfunction.

However, over half of all men with diabetes may be affected and the possibility of problems increases with age.

One of the most common sexual problems
is erectile dysfunction (ED or impotence). This is an inability in getting and/or keeping an erection for sexual intercourse.

Most men experience difficulties in achieving an erection at some time in their lives, and 10 per cent have continuing erection problems. ED affects both heterosexual and homosexual men.

You may experience sexual dysfunction that is caused by physical factors or the medication you are taking, or a combination of both. As well as diabetes and related complications, emotional and lifestyle factors can also contribute to sexual dysfunction.

It is important to be aware of the some of the links between causes and symptoms so that you can find the most effective help and support. There is now a wide range of treatment options available for men with erection problems.

Getting further help

Whether you are male or female, admitting you experience sexual dysfunction can be difficult for many reasons. But seeking help and support is the first step to overcoming the problem.

Once you have tackled the first hurdle of accepting help, getting the right support should improve your sex life. Sexual dysfunction is more common than you may think, and finding out more about your symptoms and realising you are not alone in your experiences can be comforting and reassuring.

Professional help

It is important you try and speak to a healthcare professional about sexual dysfunction. Let your doctor or diabetes specialist nurse know how you are feeling.

Recognition of sexual dysfunction is increasing and there are now more professionals who can help and more treatments available – some of which are available through the NHS.

Finding the cause and the right treatment for sexual dysfunction can be complicated, however the right advice can help people adjust to physical changes and explore different ways of regaining a fulfilling sex life.

If you are anxious, embarrassed or don’t know what to say, write down what you need to express and take it with you. This can help both the healthcare professional and you to get the consultation under way.

Your doctor will be able to refer you, if necessary, to a sexual and relationship therapist. It is quite appropriate to discuss any sexual problems you may be having at your annual review for your diabetes – you should consider it part of your review.

It is important that your doctor knows about any sexual dysfunction, as it can be a symptom of heart disease due to damage to your large blood vessels.

If you are already being treated for heart disease, the medication you are taking and your level of health will influence diagnosis and treatment of sexual dysfunction, therefore the decision about which treatment to use should be made by you and your doctor or diabetes specialist nurse.

Your partner

If you have a partner and you are experiencing sexual dysfunction, it is essential you try to discuss this issue with them.

Talking openly is a key part of helping to solve the problem, as it breaks down barriers and helps you understand each other’s sexual and emotional needs.

Although discussing sexual dysfunction can be very difficult, not discussing it can make the problem worse. It’s also a good idea to encourage your partner to be involved in your treatment, for example, by accompanying you on your clinic appointment.

Check out your lifestyle

• Cut down on alcohol - remember the term ‘Brewer’s droop’? It is true.
• Give up smoking -  nicotine stops the blood flow to the area of the penis associated with erections.
• Exercise regularly and eat healthily - this will improve your blood glucose control and your general feelings of well being.

Make time to relax

Make time to relax and have fun, both alone and also as a couple. Remember that stress plays an important part in ED. Finally, take time to enjoy being sensual as a couple. Make time for a relaxing massage together, for example, without any expectations of sex.

Coping strategies

It is also important to develop your own coping strategies to help you function despite feeling the psychological impact of sexual problems.

If possible, take a break from stressful life events to recharge. If necessary, ask for a bit of support from family, friends or employers. If you continue to feel low and pressured for more than two weeks, it is vital you speak to your healthcare professional or diabetes team.

When it comes to your diabetes management, have realistic expectations about what you can achieve. For example, if you want to be more active but hate gyms, don't join a gym. Find other ways of increasing your activity levels, for example walking, rather than driving or taking public transport.

Take a good look at how you've managed change in the past. Are you good at caring for other people’s needs but have great difficulty acknowledging your own? In an average week, how much time is devoted to just you and your needs. If you don't have at least a few hours, not including sleep, for yourself, perhaps you cope and care for others but forget about yourself.

Just as a poor diet and very little physical activity are bad for your diabetes management, they can also contribute to negative feelings or depression. Eating healthily (but not restrictively or rigidly) and using more energy can help lift mild depression. 

Relaxation techniques, such as yoga or T'ai Chi, or even attending evening classes, can also be of benefit. 

Further information

If you would like to discuss any of the issues in this booklet, call Diabetes UK Careline on 0845 120 2960*.

The Careline can provide confidential support and information on diabetes and related issues. All team members are trained and experienced counsellors.

You may also like to contact the following organisations for information:

The Sexual Dysfunction Association

Suite 301, Emblem House
London Bridge Hospital
27 Tooley Street
London SE1 2PR
Telephone helpline: 0870 774 3571
Email: info@sda.uk.net

British Association for Sexual and Relationship Therapy (BASRT)

PO Box 13686
London SW20 9ZH
Telephone: 020 8543 2707
Email: info@basrt.org.uk

Relate

Central Office, Premier House
Carolina Court, Lakeside
Doncaster DN4 5RA
Telephone: 0300 100 1234
Email: enquiries@relate.org.uk 

How it affects me

It may be of great comfort to read about other people who are already experiencing sexual dysfunction. Realising you are not alone and seeing there are other people in a similar situation can offer great support.

Reading about somebody else's way of dealing with a problem may also give you renewed confidence to look at your situation in a different light, or offer solutions which you may have missed.

These are the stories of people who have experienced sexual dysfunction.

We hope it will help you realise that help and support is at hand.

If you have a story you want to tell which may help or encourage others, we would be delighted to hear from you.

Please send us some details about yourself and your story by completing the form on the right. Or you can call the Press team at Diabetes UK on 020 7424 1000.

How diabetes affected my relationship with my wife in our 70s

To use Caverject you have to summon up your courage - in my case it was spectacularly effective.

I blame lack of desire on my medication

Friends of my age still have great sex lives. I am convinced my low libido is down to the medication I am taking – rather than my age.

Diabetes almost ruined my marriage

“We started sleeping in separate beds and eventually I couldn’t even bear to go shopping with her. We were very, very close to splitting up."

Lovemaking is a gift to my partner

"I feel no real desire at all and accept lovemaking now as a gift to my partner because I care about him."

I came to realise the problem was mechanical

"The desire was still strong, but when it came to the point of penetration, my erection simply vanished."